Provider Demographics
NPI:1558334391
Name:HUDDLE, CAROLYN (LISW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:HUDDLE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 VALLEY FORGE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:131 N EWING ST
Practice Address - Street 2:UNIT B
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3383
Practice Address - Country:US
Practice Address - Phone:740-689-6700
Practice Address - Fax:740-689-6702
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00043211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI 0004321OtherLICENSE